Abstract
BackgroundIn 2013, a government-commissioned review of school food recommended that all key stage 1 pupils in England should receive free school meals. In 2014, Universal Infant Free School Meals (UIFSM) were implemented, costing £450 million. There has been no evaluation of this policy change on pupil's diets. We assessed the effect of UIFSM on pupil's lunch and total daily intake. MethodsWe used cross-sectional surveys in 2008–09 (before) and 2017–18 (after UIFSM) in two primary schools in Newcastle (school A in most deprived ward; school B in least deprived ward) and a validated, prospective 4-day food diary. All pupils (4–7 years) were eligible to participate with written parental consent (2008–09: n=112; 2017–18 n=84). A linear regression model explored the effect of year, school, level of deprivation (pupil postcode), and the interactions between these factors on mean change in percent energy non-milk extrinsic sugars (%E NMES), calcium, yoghurt, and cake; analyses were adjusted for gender. Ethical approval for this study was granted by Newcastle University. FindingsAt lunchtime, we found evidence of a decrease in pupils mean ENMES before and after UIFSM (mean change –4·6% [95% CI –6·3 to –2·9]), which was reflected in total daily intake (–3·8% [–5·2 to –2·7]). We found a year and school interaction on mean calcium: pupils in School B had a similar mean intake before and after UIFSM; in school A, calcium intake had increased (difference between schools in calcium change –120 mg [95% CI –179 to –62]); no evidence was found of an effect in total daily intake. After UIFSM, mean portions of yoghurt decreased in school B and increased in school A (–0·25 portions [–0·46 to –0·04]); mean portions of cake increased in School B and remained similar in school A (0·23 [0·43–0·42]). InterpretationWithin the limitations of this study (repeat cross-sectional survey; only two schools) there is evidence that UIFSM contributed to a reduction in ENMES. Schools should consider implementation of healthier policies (eg, removing the daily cake choice). FundingDepartment of Health and Social Care's Policy Research Programme (Public Health Research Consortium), Newcastle University.
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